Just a few days ago, I arrived here in the heart of Malaysia. 

The capital, Kuala Lumpur, is a clean, orderly and modern city. KL, as it is affectionately known, is a thriving gateway to Southeast Asia. 

Shiny sky scrapers are clustered about the city center, motorcycles and cars pulse through the streets, banyan trees and thickets of bamboo offer oases of shade, while thick humid air enshrouds everything in unbearable heat.  At night, the Petronas towers shine like crystal. Wow!

I came here for the 13th annual International Congress on Infectious Diseases.  Doctors and scientists from all of the world met to review the latest drugs, emerging diseases, HIV/AIDS, parasitic infections and tropical medicines - it was an exciting time. 

Luckily, there is no rabies here.  Decades ago, the government resolved to eliminate that threat.  Dog control with vaccination and round-up of street animals was authoritarian but effective.  Rabies had no place to hide.  The WHO officially recognizes Malaysia as rabies-free.   Occasional rabies cases may cross over from border countries, but are quickly stamped out.

Many countries in Asia still struggle with rabies. Depending on resources and commitment, the situation varies. In Thailand, for example, the government curbed human rabies by providing free anti-rabies vaccines to anyone exposed. Expensive, but effective, human rabies cases number only a dozen or so per year. In the Philippines, reductions in rabies suffering are anticipated with the passage of the “Anti-Rabies Act of 2007″ (Republic Act No. 9482).  This law commits to wiping out rabies by 2020 from those islands.  Hopefully it will occur sooner, and with more resources it certainly could. 

RFW is gearing up to support more dog vaccination projects in the Philippines through our click2vaccinate program.  Dispatching rabies from the Philippines remains our primary goal.  We have alot of work ahead of us!

Travelers to Malaysia should check out the CDC website and confer with a travel medicine specialist before their trip.

RW

My dad always wanted to be a doctor. He grew up, the eldest of three brothers, in upstate New York. His father worked in the factories of Rochester, his mother Coletta did her best to provide. She suffered from primary biliary cirrhosis, an autoimmune disease that slowly destroys the liver. My Dad recalled that she was always sick.

Joe delivered newspapers and studied hard in school. He was driven and lucky to be gifted. He received a scholarship to St. John Fisher college. Then, he applied to Harvard Medical School and by some small miracle was accepted. Before he could graduate, Coletta passed away from liver failure. I can only imagine how awful that must have been. It fueled my dad’s passion. He would try to heal what could not be healed.

My dad was the kind of person I think of as a ‘natural doctor’. He cared about his patients beyond ‘professional’ obligations. He was like family to them. He loved them. He wasn’t afraid. Once another doctor warned him that he shouldn’t drive his patients home from the hospital – ‘You might get sued!’ he exclaimed. My dad just smiled, knowing how impossible that was.

His patients, friends and colleges came to know him as ‘Doctor Sunshine’. He always had a ready smile. Everyone was equal – everyone had a name. From the janitor on the 4th floor, to the new radiology tech, to the E.R. nurse’s mom. For almost thirty years my dad took care of people in small town Connecticut. He was their doctor. That was my dad.

Cancer took him too early. I remember I first heard the news while traveling in the Philippines. He didn’t want me to come home, but to finish my work there at San Lazaro hospital. That was typical of my dad, he always put others first.

I had hoped one day to show my dad the Philippines. There was so much work to do, so many to take care of. He would have to see it through my eyes and hear it through my stories. The Philippines was such a far away place.

For some reason, my dad never had pain during the weeks his health declined. That was another miracle. As the cancer spread, he slipped into a long sleep without suffering.

It’s hard to believe it’s been five years already since he left. I know I’ve got big shoes to fill.

RW

It all happened so fast. A ball bounced out into the street, the motorcycle lunged to avoid the tethered child. Out of instinct, her leg thrust outward, the whole weight of a collision smashed her leg into the unforgiving pavement. The pain roared.

From the X-rays I could see Serena had a severe tibial plateau fracture. Large and small pieces of bone appeared in a jumbled array. My heart sank, this was a terrible injury. She had been our clinic nurse -fast on her feet, moving patients, answering phones, pushing us onwards. Now, she was the patient.  A quick ride around the block on the back of a shiny new motorcycle ended in catastrophe.

The orthopedic doctors operated and reoperated. Could they save her leg? A framework of black steel and sterile screws, an external fixator, set her up for a long road of recovery ahead. She lay in the bed, her life changed forever. Would she ever dance again?

Every day I visited Serena in the hospital. I read from the Bible, I summoned the nurse, I held her hand, I listened. Rehab, lots of pain medicine, more rehab. She could stand now, although only for few minutes at a time. Serena was tough, but she needed support.

It took a while, a long while, before she could walk again. Her steps were slow and stiff at first. Weeks of immobilization had caused muscle atrophy, her thigh shrinking by half its size. Strength returned slowly. Then, finally, she could walk! It was a miracle!  I was lucky to be there.

Weeks after she left the hospital, I visited Serena at her home. The house was alive - kids rushed up and down stairs, soul music played in the background, the smell of fried chicken wafted through the kitchen. Her face radiated. I could see she was ‘back’. Could she dance? I smiled at the thought - I knew she could.

It is easy to take things for granted:  a walk outside, sunshine, good health, life without pain.  Remember to give thanks - each day is a gift, make the most of it.

RW

I’ve just finished Stephen King’s book, On Writing, which a friend of mine gave me.  It was a brilliant read – inspirational, riveting, and funny - a ‘personal masterpiece’.  Stephen interweaves his life experiences into an encouraging guide of the writer’s craft. It’s a story that’s meant to be told:  From humble beginnings to a troubled youth, through difficult times to success despite severe obstacles, and finally to a wisdom earned.

His stories and dark themes terrify me.  Cujo is based on the terror of a rabid monster of a dog.  Misery describes the psychotic tendencies of a fan who ‘hobbles’ her victim with a bone-crushing whack of a sledgehammer.  Yikes!

What I hadn’t known about was Stephen’s unfortunate experiences with the medical system.  I always try to pay attention to this, as a good doctor should maintain the right perspective.   He went through a hellish series of treatments for a chronic ear infection as a child.  Far worse, was his peds vs. van accident in 1999 which badly mangled him.

It was a ‘miracle’ that he survived those injuries – especially in rural Maine.  Fortunately he received lifesaving medical attention within the ‘golden hour’ of trauma and was medi-evaced to a tertiary care center where they could repair his shattered frame.  I’m hoping he’s fully recovered from that horrible day, but scars must remain.  At least he has his life to be thankful for, his family and of course the writing.  We’re lucky we didn’t lose him there.

I feel a new inspiration.  King’s mantra is ‘read’ and ‘write’ – something I wish I could do more of.  My ‘day job’ soaks up most of my time, but I’m feeling inspired –I will try to blog more.

Stay tuned, stay safe.  RW.

Rabies.  The sound of the word sends a chill down
my spine. I have seen what this virus can do, and it’s very very frightening:  Hydrophobia, ‘foaming at the mouth’, psychotic screaming, savage agression, immunity to pain.  These are symptoms of a dark, terrifying Force - a Fury unleashed.

It astounds me to know that in this 21st century, such an ancient, Evil disease can flourish in so many parts of the world.  It truly is ’madness’.

Rabies is one of the ‘neglected’ diseases of our time.  It is 100% vaccine preventable, yet 100% fatal once symptoms are present.  No other infectious disease has such an unforgiving mortality rate.  Ebola, by comparison, carries at least a 10% chance of survival. 

Miracles do occur (see Jeanna Giese) but certainly not enough of them.  We need more miracles out there, especially for the 55,000+ people who die from rabies every year according to the World Health Organization (WHO).  The fear, the terror I’ve seen in children’s faces suffering from rabies haunts me.  I wish somebody would do something…

Rabies experts in the Philippines have estimated that for just 10 million dollars, rabies could be wiped out from those islands.  It would take a large scale vaccination and dog control program.  Other countries of similiar socio-economic status have done it - like Mexico for example.  Until now, though, ‘lack of funds’ has prevented real progress against this scourge.

Fortunately, March is ‘Rabies Awareness Month’ and the Department of Health, other governmental agencies, non-governmental organizations (NGOs), other partners and volunteers have teamed up for a month long rally of ‘rabies awareness’.  We here at RFW hope to help as much as possible to reduce rabies suffering.  We know have a lot of work ahead of us!

This year we plan to vaccinate more dogs in the Philippines to spare the animals and prevent the disease from reaching humans.  With our ‘click to vaccinate’ program in partnership with CARA (Compassion And Responsibility for Animals), just a few clicks can send a donation on its way to save a dog and protect the people.  Please click2vaccinate if you think you can help ‘Stop the Madness’.

Thanks for your support, RW.

February 29th is a special day - not
just because it’s that extra day in February of the ‘leap’ year, but it’s also my former rowing coach’s birthday.

I remember with fondness the days when
Ken Sabbag was our Novice Men’s rowing coach at Wesleyan. I had signed up for ‘crew’ as a college freshman because anyone who was interested could join. At the time, I had little insight into what rowing was all about. Through Ken’s leadership and my experiences, I came to appreciate probably ‘the ultimate’ in team sports. Crew meant dedication and commitment, hard work and endurance, sacrifice and pain. Yet a special camaraderie was formed during those times. Friendships were forged that I still treasure almost 2 decades later. Giving your all for the team, the ‘crew’, meant something. Testing ourselves beyond anything we could have imagined or expected brought out the best in us.

Ken was there to guide us. He was our mentor, our guru, our coach. His rallies and guiding speeches after a long arduous practice were an encouragement to do more and to ‘be’ more. I felt that I learned not just to ‘row well’ but to ‘live well’ under his guidance.

Our novice team improved throughout the Fall. We practiced on the Connecticut River during the early dawn, when boat traffic and winds lolled. Eight oars moved effortlessly above the water, extending back as far as possible, before all at once turning suddenly downwards to splash into the water and pull. Fire and rage pulsed through us: The quadriceps hammered down, the back unleashed a Fury, the lats and arms crushed the Life Force from the stroke. Then, again, Tranquility. Peace. The boat glided effortlessly under us, as we strove for poise. Stroke! Again, the power surged, steam rose up in a cloud from the oarsmen intent on a punishing unity. Water could be seen boiling at the blades. Then, Serenity. Birds floated high above on cushions of air. “Kill that bird”! Electricity sparked through the Shell, Power surged forth from a collective rage. This was Beauty, this was Rowing, this was Life to us.

One early morning, our eight swept along a mirror still section of water. Ken was far off in the skiff, watching our motions from a distance - to observe the synchrony so important to the sport. Suddenly one of us cried out. The coxswain ordered us to ‘weigh enough’ and the boat cruised before slowing to a stand-still. We looked out in amazement to where Ken was. What we saw seemed like a miracle! Ken appeared to be walking on water - he was out of his boat, moving, far from shore. ‘What on Earth’? Before we knew it, he was back in the skiff, humming along. The coxswain ordered us to resume. “Eyes in the boat” was our command; the power and pulse of the Shell returned.

That day has remained a strong memory for me. Exactly what happened isn’t quite clear - was it a shoal, an underwater branch, some illusion? It didn’t matter so much for me or the crew, we knew Ken was capable of walking on water. We loved him.

Ken had to move on from coaching us. He went to medical school at one of the most prestigious schools in the U.S., then orthopaedic residency at Harvard with a specialty in Hand surgery. He practices now in Pasadena California. I’m sure his patients must experience many miracles through his caring hands.

Happy Birthday to you Ken, our coach.

RW

I’ve just seen the ‘the Bucket List’ which stars Morgan Freeman and Jack Nicholson.  I thought it was a wonderful film and well worth seeing.

This movie was about miracles, particularly the small, personal kind. I felt very inspired- I laughed and I cried through this story of courage and love. The film gave a ‘big picture’ perspective to life.

The premise of the movie (without giving too much away) is that two random people become friends while sharing a hospital room together.  Their friendship blossoms, partly because of the life-changing events forced upon each character.  They create a so called ‘Bucket List’ of things to do before they ‘kick the bucket’. Of course, the list contains a few concrete goals in life, such as seeing the Great Pyramids of Eygpt, or skydiving, but actually goes far beyond into the spiritual realm.

I felt like most of the movie-reviews I read about the film missed the entire point. Sometimes it takes a lifetime to recognize what is truly marvelous in life. An important aspect of the movie was to show that life’s greatest moments are often just there waiting for us to awaken to them. When you see the film, you’ll understand more.

In the medical field, when I see a terminally ill patient fully enjoy a day, it is wonderful.  I believe in quality of life, which is something often overlooked in the US medical system.  When families of patients can realize that, it makes it easier on them too.  Letting go of a loved one is extremely hard.  Life is amazing as it is, a miracle. 

‘The Bucket List’ offers hope, triumph and love, set against the realities of Nature.  Two men with seemingly insurmountable obstacles in life undertake a figurative and real journey that adds so much more to their lives.  It seemed like a wonderful therapy we could all learn from.

I think this film showcases the greatness of human nature.  We all have this potential - whether we know it or not.  We should learn to make the most of the time we have and find the meaning in our lives.

I think you will like this movie too.

You can see the trailer at:  http://thebucketlist.warnerbros.com/ 
RW

There has been a lot of media buzz about MRSA recently. In a way, it is good that finally some attention is being paid to this problematic ‘superbug’. There should be more health education in this country, as evidenced by the palpable fear spread by these news headlines.

MRSA or Methicillin Resistant Staphylococcus Aureus has actually been around for decades. Humans and microbes have been engaged in an ongoing battle ever since the development of the first antibiotics. Penicillin came into widespread use in the 1940s. Staph aureus or ‘Staph’ pretty soon figured out a way to overcome this ‘poison’ and resistant strains started emerging. Penicillin at first seemed like a ‘miracle’ drug. Patients who were supposed to have died from infections were saved!

I remember an old retired doctor, Dr. Chotkowski, who lived at the end of our street. He described to me his first time using penicillin in 1943 to save the life of a young girl from Staph sepsis. In those days, big doses were given with big needles in the butt. Painful to think of, but at least this girl lived thanks to this new medical breakthrough.

Soon, however, the microbes realized they had to respond. It was a fight for survival. Staph resistance to penicillin became widespread over the next few years. Modifications and enhancements to the original penicillin molecule extended its usage and the ‘penicillin class’ of medications was born. Methicillin was created as a ‘super penicillin’ to overcome resistant Staph. For a time, methicillin worked well. However, Staph was not to be outdone, and the first MRSA strains were discovered in the early 1960s. These strains circulated and became more widespread. Now, in our hospital in Connecticut, almost 60% of Staph strains are MRSA. This is quite different from what is found in the community, however, where among ordinary people the percentages are much lower.

Doctors actually divide up MRSA into ‘hospital associated’ (HA-MRSA) and ‘community associated’ (CA-MRSA). In the first group, the hospital MRSAs typically have multiple resistances to various antibiotics. That’s bad news because it makes the treatment more difficult. The selection of antibiotics to choose from is more limited and the chances for failure are higher. Also, there can be more side-effects from treatment, the length of stay in the hospital can be longer and of course the costs can be higher.

In Community Aquired MRSAs, resistance is confined usually to just a few antibiotics. This means that a good doctor can still give a patient the right treatment.

In general, it is good practice to cover all the bases with a broad spectrum antibiotic first, then refine the therapy once we culture something out. The microbiology lab is very helpful in that regard because they can take a specimen from the patient and grow the germ for us – testing all its weaknesses and strengths. Armed with this roadmap, doctors can more effectively destroy these germs that are trying to harm us.

It’s uncomfortable to think that the ‘bugs’ are getting smarter. I believe though that ‘we’ still have the upper hand. New medications are being developed against MRSA and other ‘superbugs’. Having a specialist like an Infectious Diseases doctor contribute to your care may help. And of course, seeing your doctor before things spiral out of control is always a good idea.
RW

I’ve been watching that show ‘Man vs. Wild’ on Discovery channel. If you haven’t seen it yet, you might want to tune in. Discovery has a schedule on the web (see http://dsc.discovery.com).

I first happened upon ‘Man vs. Wild’ just channel surfing, but within a few minutes of watching, I was hooked. Here was some great TV – which is hard to find these days. I don’t know why television in general is so pandering – I often wonder why the networks just don’t strive to make great programs and worry about the audiences secondarily. I think ‘build it and they will come’ should apply –even though it might seem riskier. Just consider the “Lord of the Rings” trilogy for example – what a Masterpiece!

Anyway, here’s this guy Bear Grylls, who by some miracle survived and recovered from a broken back after a parachuting accident. Now his assignment is to lead the viewer through some harrowing wilderness challenge. The show is a great mix of adventure, amazing natural beauty, perseverance, intelligence and ultimately triumph. I think this program inspires hope. I may not get outdoors that much, but I feel like I could spring into the back yard at any time, climb over the fence and into the wild mountains beyond.

I’ve seen many ‘cord’ victims in my career, since my training hospital had a spinal cord center. I dreaded to see them, since paralysis is such an awful curse. As a doctor, you wish you could do more, but with devastating neural injury, sometimes there was just nothing you could do. Bear must have been very lucky and I’m sure a miracle occurred there.

I’m hoping Bear’s luck holds out. Last week I saw his ‘Panama’ episode, where he and the crew traverse through a bat infested cave in pitch darkness. He didn’t report the species of bat, although he suggested they were vampire bats – Desmodus rotundus. Whether or not that was the correct species is irrelevant, since rabies is actually a ‘bat’ virus and could be transmitted by any number of bat species.

Apparently on the show a bat flew right into Bear’s face! To me, that seemed like a worrisome event. I tried sending Bear an email through his web page indicating he should get vaccinated for rabies. I’m not sure it went through though because of some ‘busy server’ message I got in return. Maybe I should try contacting his agent?

Something as simple as a scratch from a wild animal like a bat could be enough to transmit rabies or rabies like viruses (called Lyssaviruses). And bats, like all wildlife, must really be respected. The key to recognizing the problem here is that bats and humans shouldn’t mix. I immunize a lot of patient’s in my clinic who have bat exposures. With rabies, you have to be 100% right, since rabies is fatal once symptoms appear.

For example, last year in Texas, a teenage kid had a bat fly through an open window and land on his face. The boy tossed the bat out the window and it subsequently flew off. Nothing else was done. Months later, he unfortunately developed the symptoms of rabies and died despite heroic efforts to save him. This was a tragedy that could have been avoided if the public just knew about the dangers of rabies from bats.

That’s why RFW has been so interested in making a thoughtful, interesting documentary about rabies. Television is a great way to reach people, and I think it’s vastly underutilized. I hope one day a real revolution in TV will take place. Bear’s show at least is refreshing and in my opinion worth watching. Looking forward to next week…
RW

It was mid-April in Bangkok and I was visiting Thailand to help educate the public there about the dangers of rabies. 

I was thrilled to be going around this city with Mali - a friend of mine who worked in film.  What a far off place this was - exotic temple architecture, huge sky scrapers, amazingly good food, crowds of people everywhere.  Traffic clogged the streets.  The noise from tuk-tuks - small carriages with motorbike engines- buzzed through the air.  It was the hot season, but I didn’t mind, it just added to the mystique of this steaming metropolis, the gateway to beautiful Thailand.

Mali wanted to know all about rabies, since she knew it was a real danger.  There were plenty of street dogs in Bangkok.  You could see them roaming and foraging for scraps of food.  They appeared similar to the street dogs I’d seen elsewhere in Asia - a rather thin mangy breed.  There were of course other animals too, including a small elephant brought along one of the main tourist streets for the farangs to gawk at.

My friend peppered me with questions about rabies.  She was concerned about her sister, Pho, who loved street animals and was always trying to care for them.  Pho had actually taken in six cats.  She was constantly getting scratched and occasionally nipped by the street animals since she was taking care of them whenever she could.  I became somewhat alarmed to realize that Pho was at a real risk for rabies.  The government of Thailand had done a good job of controlling rabies compared to some other countries, but the threat was not totally eliminated.  They report 20 to 30 human cases a year -much improved- but still too many.  This meant we had to find Pho very soon and make sure she was vaccinated against this horrible disease.

Pho was just a teenaged kid.  She was happy-go-lucky and always had a ready smile.  She was a compassionate person, especially towards animals.  Like most Thais, she of course had a cell phone.  So we called her up and arranged for her to come the next day to the Thai Red Cross hospital. 

Pho was wearing a short pink jacket with a frilled white neckline and blue jeans.  Her hair was an auburn hue, feathered like a rock-star.  Her face seemed of porcelain, with dark eyes flashing as she greeted us.  Bubble-gum glossy lips pursed into a smile - a perfect array of white teeth.  ‘The Land of Smiles’ I thought to myself.  These people were so friendly - it was great to visit Thailand and meet them.

Luckily there weren’t many people ahead of us at the Animal Bite Treatment Center, so we didn’t have to wait to long.  It turned out that Pho actually knew one of the nurses!  ‘What a small world’ I thought.  The staff were interested to hear about Pho’s interaction with the street animals.  She had been scratched by a mangy dog just the week before.  She had been trying to take care of it since it was skinny and rather forlorn.  The dog in its excitement had leapt up at her and accidently scratched her arm.  Given that rabies is 100% fatal, this wasn’t something that could go unignored.  Pho got her first treatments that day and was scheduled to come back a few times more for all the shots.  The nurses worked quickly, so it really wasn’t too bad.

We felt better knowing Pho was protected.  She could go back to her work of caring for the street animals safer because of a few shots.  We’re hoping that soon Bangkok and the rest of Thailand will be rid of rabies once and for all. 
RW